New Commonwealth modelling highlights a growing mismatch between the doctors coming through the system, specialist training capacity and the workforce communities need.
The Australian Government's Whole of Medical Workforce Supply and Demand Study, released in June, projects that by 2048 Australia will have 10,783 FTE more hospital prevocational doctors than modelled demand, while facing shortages of 3,885 FTE registrars and 12,812 FTE specialists.
The Commonwealth says increasing numbers of medical graduates will create further growth in the number of prevocational doctors awaiting training positions, creating bottlenecks, prolonging training and increasing job uncertainty for junior doctors.
RACS president Dr Phil Morreau says the report, as well as RACS' own specialty-specific modelling, shows the challenge was not simply the number of doctors entering the system.
"The paradox is that we can have more doctors coming through the early stages of the system while simultaneously facing a shortage further down the pipeline. That tells us the problem is not simply how many doctors we have, it is whether we have the right training pathways and capacity to develop the specialist workforce Australia needs."
For doctors seeking surgical careers, the mismatch can mean spending years working outside accredited specialist training while building experience and competing for training positions.
"These doctors are not simply waiting to train," Dr Morreau says.
"They are already contributing to our hospitals and patients. We need to recognise that contribution and give doctors greater clarity about pathways into specialist training."
Commonwealth data shows hospital prevocational doctors worked an average of 46.8 hours a week in 2023, with 94 per cent of their FTE in the public sector. The Commonwealth also identifies increased reliance on service registrars to manage service delivery as one of the workforce issues arising from current imbalances.
RACS recognises that it has a responsibility to improve the parts of the surgical training pathway within its control, that is, selection, accreditation and surgical training
Its Surgical Pathways Strategy is focused on making pathways more transparent, fairer and more efficient, including recognising relevant capabilities acquired before formal specialist training where appropriate and better aligning training with workforce need.
"We recognise that we can do better," Dr Morreau says.
"That means clearer selection processes, more flexible pathways and training that reflects the surgical workforce Australia needs now and, in the future, including in regional and rural communities."
But RACS cannot create funded training positions or the clinical capacity required to train surgeons.
RACS accredits training programs and settings, selects candidates and oversees surgical education and training. Governments and health services play a critical role in providing the funded positions, clinical environments, operating capacity and supervision required for specialist training.
"We cannot create more training positions on our own," says Dr Morreau.
"A training position needs a funded job, appropriate supervision and sufficient clinical exposure to develop a competent surgeon. We need governments, health services and colleges working together to increase that capacity where it is needed."
The Commonwealth report emphasises that no single organisation can solve the medical workforce pipeline and calls for collective action across governments and the health sector. It also says the modelling is intended to inform decisions about medical student numbers, specialist training places and the distribution of international medical graduates.
RACS supports increasing high-quality accredited surgical training capacity, planned against specialty and geographic workforce need rather than simply increasing training numbers indiscriminately.
This includes opportunities through public hospitals, regional and rural services, appropriate private-sector settings and a more stable and strategic Specialist Training Program.
"The answer is not to lower surgical standards," Dr Morreau said.
"We should solve a specialist workforce shortage by building a better pathway to train the doctors Australia already has, and by making sure those training opportunities are available where communities need surgeons."
